是口腔科牙齒疾病最常見的癥狀之一。很多牙病能引起牙痛，常見的有、急性、慢性牙髓炎、牙周炎、等。此外，某些神經系統疾病，如三叉神經痛、周圍性面神經炎等；身體的某些慢性疾病，如病患者牙髓充血、糖尿病患(huan)者牙髓血管發炎壞(huai)死等都可引起(qi)牙痛(tong)。

　　※牙髓炎

　　部分牙髓炎病人在用冷水(shui)時疼(teng)痛(tong)明顯(xian)，而改(gai)用溫水(shui)便覺(jue)(jue)得沒那么痛(tong);還有一些病人在吃飯(fan)喝(he)熱湯(tang)時也覺(jue)(jue)得痛(tong)，要等(deng)湯(tang)放涼了(le)才能(neng)喝(he);如果繼續發(fa)(fa)展(zhan)，有的病人會(hui)無緣無故地(di)痛(tong)起來，特別是到了(le)晚上躺下睡覺(jue)(jue)后，會(hui)痛(tong)得更厲害，甚至(zhi)影響。這就(jiu)是醫生常(chang)說的“冷熱刺激痛(tong)、夜(ye)間自發(fa)(fa)痛(tong)”。

　　牙(ya)(ya)(ya)髓(sui)炎(yan)(yan)(yan)的(de)(de)(de)(de)炎(yan)(yan)(yan)癥部位(wei)在(zai)牙(ya)(ya)(ya)齒中央的(de)(de)(de)(de)牙(ya)(ya)(ya)髓(sui)腔(qiang)，藥(yao)物(wu)要(yao)通過細(xi)小的(de)(de)(de)(de)根尖孔才(cai)能到達，可(ke)(ke)以(yi)說任何藥(yao)物(wu)都不(bu)可(ke)(ke)能徹底治療(liao)牙(ya)(ya)(ya)髓(sui)炎(yan)(yan)(yan)，所(suo)以(yi)牙(ya)(ya)(ya)髓(sui)炎(yan)(yan)(yan)“無(wu)藥(yao)可(ke)(ke)治”的(de)(de)(de)(de)說法(fa)是(shi)(shi)有(you)(you)一定道理的(de)(de)(de)(de)。不(bu)少(shao)牙(ya)(ya)(ya)髓(sui)炎(yan)(yan)(yan)病人(ren)牙(ya)(ya)(ya)痛(tong)(tong)時(shi)病急亂投(tou)醫(yi)，那些不(bu)專業(ye)的(de)(de)(de)(de)醫(yi)生(sheng)隨便開點抗生(sheng)素給(gei)病人(ren)用(yong)，結(jie)果完全(quan)不(bu)起作(zuo)(zuo)用(yong)。對(dui)于(yu)牙(ya)(ya)(ya)髓(sui)炎(yan)(yan)(yan)造成(cheng)的(de)(de)(de)(de)疼痛(tong)(tong)，有(you)(you)一定的(de)(de)(de)(de)作(zuo)(zuo)用(yong)，而當疼痛(tong)(tong)劇烈時(shi)，止痛(tong)(tong)藥(yao)的(de)(de)(de)(de)作(zuo)(zuo)用(yong)就不(bu)明顯了。像“牙(ya)(ya)(ya)痛(tong)(tong)丸”一類的(de)(de)(de)(de)局部止痛(tong)(tong)藥(yao)在(zai)疼痛(tong)(tong)輕微時(shi)可(ke)(ke)能有(you)(you)效，但并非好(hao)辦法(fa)。當發生(sheng)牙(ya)(ya)(ya)髓(sui)炎(yan)(yan)(yan)時(shi)，比較好(hao)是(shi)(shi)找牙(ya)(ya)(ya)科(ke)醫(yi)生(sheng)，對(dui)病牙(ya)(ya)(ya)進行(xing)治療(liao)和處(chu)理，在(zai)看牙(ya)(ya)(ya)醫(yi)之前已(yi)經(jing)有(you)(you)疼痛(tong)(tong)的(de)(de)(de)(de)可(ke)(ke)以(yi)口服止痛(tong)(tong)藥(yao)，其他藥(yao)物(wu)建議都不(bu)用(yong)。

　　※根尖周炎

　　一般情(qing)況(kuang)下(xia)，牙(ya)(ya)髓炎(yan)進一步發展，細(xi)菌(jun)侵(qin)犯到(dao)(dao)牙(ya)(ya)根尖(jian)周(zhou)(zhou)(zhou)圍的(de)(de)組織便造(zao)成了根尖(jian)周(zhou)(zhou)(zhou)炎(yan)。炎(yan)癥早(zao)期病(bing)人會覺得牙(ya)(ya)齒有(you)浮起感(gan)，容易咬(yao)到(dao)(dao)病(bing)牙(ya)(ya)，牙(ya)(ya)齒咬(yao)合時(shi)感(gan)到(dao)(dao)疼(teng)(teng)痛(tong)(tong)。早(zao)期由于(yu)炎(yan)癥的(de)(de)范圍比較小，使用抗(kang)生(sheng)素(su)和消(xiao)炎(yan)止痛(tong)(tong)藥對控制炎(yan)癥雖有(you)一些幫助，但意義不大。專業的(de)(de)牙(ya)(ya)科醫(yi)生(sheng)仍(reng)然(ran)強調局(ju)部(bu)引流和局(ju)部(bu)用藥，醫(yi)生(sheng)通常(chang)會從牙(ya)(ya)齒疏通到(dao)(dao)根尖(jian)周(zhou)(zhou)(zhou)圍的(de)(de)組織，并在局(ju)部(bu)放置消(xiao)炎(yan)止痛(tong)(tong)藥物，如(ru)樟腦(nao)酚等(deng)(deng)。根尖(jian)周(zhou)(zhou)(zhou)炎(yan)病(bing)人如(ru)果沒有(you)得到(dao)(dao)及(ji)時(shi)治(zhi)療，炎(yan)癥范圍擴大，可(ke)能出現面(mian)頰(jia)部(bu)紅(hong)腫熱痛(tong)(tong)、化膿，甚至出現發熱、全身疼(teng)(teng)痛(tong)(tong)等(deng)(deng)癥狀。這時(shi)，就有(you)必要對全身使用抗(kang)生(sheng)素(su)和消(xiao)炎(yan)止痛(tong)(tong)藥(廣譜抗(kang)生(sheng)素(su)和滅滴靈即甲硝唑是常(chang)用的(de)(de)藥物);疼(teng)(teng)痛(tong)(tong)者(zhe)可(ke)以加用去痛(tong)(tong)片等(deng)(deng)止痛(tong)(tong)藥，疼(teng)(teng)痛(tong)(tong)劇烈者(zhe)還可(ke)以在病(bing)牙(ya)(ya)周(zhou)(zhou)(zhou)圍注射局(ju)部(bu)麻醉劑，如(ru)普魯卡因等(deng)(deng)。

　　※冠周炎

　　冠周炎(yan)多發生(sheng)(sheng)于下(xia)頜(he)智齒萌出不(bu)全或(huo)阻(zu)生(sheng)(sheng)時(shi)(shi)，牙(ya)冠周圍(wei)軟組織發生(sheng)(sheng)炎(yan)癥。炎(yan)癥初期，病人覺得(de)牙(ya)齦腫脹疼(teng)(teng)痛(tong)(tong)，咀嚼(jiao)吞咽或(huo)開(kai)動時(shi)(shi)疼(teng)(teng)痛(tong)(tong)明(ming)顯(xian)，隨著病情發展(zhan)疼(teng)(teng)痛(tong)(tong)加重;嚴重時(shi)(shi)還可(ke)出現(xian)不(bu)同程度(du)的(de)無法張口，甚至(zhi)牙(ya)關緊閉。治療(liao)以局(ju)部(bu)(bu)處理為主，常用(yong)(yong)生(sheng)(sheng)理鹽(yan)水和(he)2%雙氧水沖洗局(ju)部(bu)(bu)，再放(fang)置(zhi)碘甘油，比較好每日1～3次，再用(yong)(yong)洗必泰(tai)漱口液漱口。如果有膿腫形成，應(ying)及時(shi)(shi)切開(kai)排膿。如果出現(xian)面(mian)頰(jia)部(bu)(bu)紅腫熱痛(tong)(tong)，甚至(zhi)全身發熱、疼(teng)(teng)痛(tong)(tong)等，可(ke)以使(shi)用(yong)(yong)抗生(sheng)(sheng)素(su)和(he)消炎(yan)止(zhi)痛(tong)(tong)藥(yao)，常用(yong)(yong)的(de)藥(yao)物也是廣譜(pu)抗生(sheng)(sheng)素(su)和(he)滅滴靈(甲硝(xiao)唑)等。

　　無論(lun)根尖(jian)周炎或冠(guan)周炎，如(ru)果(guo)病(bing)情得不到控制，容易形(xing)成口(kou)腔頜面部間隙感(gan)染，這時還可考慮靜脈注射抗生素，醫(yi)生應根據病(bing)人(ren)的情況(kuang)選擇藥物，如(ru)青霉(mei)素等。

　　綜上(shang)所述，牙(ya)(ya)疼時(shi)首先(xian)(xian)應(ying)考慮請專科醫(yi)生(sheng)診治(zhi)，先(xian)(xian)進行(xing)局部處理，必要時(shi)才使用(yong)抗生(sheng)素和止(zhi)痛(tong)(tong)藥(yao)。市面上(shang)有(you)一些(xie)藥(yao)，聲(sheng)稱能(neng)治(zhi)療牙(ya)(ya)痛(tong)(tong)、牙(ya)(ya)周疾病等(deng)，而事實上(shang)專業口腔(qiang)科醫(yi)生(sheng)基(ji)本不(bu)開這些(xie)藥(yao)，不(bu)經過局部治(zhi)療而僅靠藥(yao)物是不(bu)能(neng)解(jie)決問題的，甚至還會延誤病情。

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